When a company has been around as long as Plymouth, Minn.-based Thrifty White Pharmacy — which traces its roots to the 1884 opening of White Drug in what was then the Dakota Territory — there is an expectation that to stick around, it has to adapt to changes in the industry to stay in business. But rather than be content following its competitors’ leads in an effort to simply keep the lights on, Thrifty White has been on the front lines of adapting early to the biggest changes impacting the pharmacy business.

Thrifty White has been on the forefront of trends hitting the industry since it began its medication synchronization program about eight years ago. Since that launch, Thrifty White’s med sync program has grown to include some 65,000 enrolled patients whose prescriptions are filled centrally and picked up monthly. Also in the years since its med sync launch, Thrifty White has grown its Affiliate Pharmacy program to include 84 independent pharmacies, built out its long-term care business, entered the specialty space and unveiled a new store format that provides designated clinical rooms for patients’s appointments with pharmacists, among other efforts.

And Thrifty White has made all of this progress while remaining employee-owned and “continuously working at how you’re going to exceed expectations,” as president and CEO Bob Narveson told Drug Store News. For all of these efforts and its work toward delivering healthy patient outcomes while controlling costs in an increasingly costly industry, Thrifty White has been named DSN’s Pharmacy Innovator of the Year.

It could be said the first time Thrifty White was ahead of its time was when co-founder Mrs. H.E. White became the first female pharmacist in the Dakota Territory. But it became clear Thrifty White was ahead of the med sync curve in 2013, when alongside pharmacy technology provider Ateb, Virginia Commonwealth University released a study of Thrifty White Pharmacy patients that found improved adherence rates among patients enrolled in sync when compared with patients who weren’t enrolled. At the time, the company had enrolled about 30,000 patients, and since then has more than doubled that number. Thrifty White’s appointment-based model, by centrally filling a patient’s medications that can be picked up during a monthly appointment, puts the pharmacist, their knowledge and potential clinical services at the center of the patient’s experience.

“What it does allow us to do is sit down with the patient based on what their needs are every month, and we find out those needs about 10 days prior because we reach out to those patients and see if there’s been any changes in their drug regimens or any doctor visits or hospitalizations,” Thrifty White COO Tim Weippert told DSN, noting that based on this, pharmacists can offer immunizations or such clinical services as medication therapy management and comprehensive medication reviews.

“We can layer in all these various services that a patient might need, depending on what the circumstance is each and every month, so it’s a very high-touch, engaged process,” Weippert said.

This model is at the center of Thrifty White’s new Healthy Outcomes store format, which has been rolled out to 41 locations so far and includes two additional clinical suites to accommodate additional patient-pharmacist engagement — an element that the company also has placed at the center of its specialty pharmacy services.

Having received accreditation from URAC and CPPA — the latter of which opened up specialty pharmacy services to its Affiliate Pharmacy partners — Thrifty White Specialty Pharmacy has seen double-digit script growth this year, and the company has taken the model that’s proven successful with its med sync program and extended it to the way it fills specialty prescriptions.

“We’ve taken that same model and done the same thing with our specialty patients so that they can have face-to-face interactions,” Weippert said, adding that “the importance of the brick-and-mortar, local access and the patient’s desire to have that access to their pharmacist are all reasons why we do that.”

Thrifty White’s ability to fill specialty prescriptions locally and enable patients to receive their specialty medications from the pharmacy team they know has been one of the several jobs with which the company’s Community Health Specialists have been tasked. The team works in the communities Thrifty White serves, talking to employers — with whom Narveson said the company has had success — and physicians about what Thrifty White can offer their employees and patients.

“We’re going out and marketing our services and making sure they’re aware of all the things we do provide and can provide for their patients around medication synchronization, specialty and different types of screenings,” Weippert said. “We just want them to be fully engaged and make sure they understand all the services that are available within the community. It’s a community-focused situation. We want those people to enjoy the ability to have brick-and-mortar, face-to-face, local access wherever they want it.”

The level of service that Thrifty White offers is, according to Narveson and Weippert, the result of the dedication from its employee-owners. Thrifty White remains employee-owned, with its largest shareholder possessing a 3% stake in the company. Every year it reinvests in its employees, cashing out exiting shareholders and reinvesting that stock into continuing employees. By literally investing them in the company, Narveson said its employees become more invested in the business and in the effort they put in to the success of the organization and patient care.

“Pride in ownership, and the dedication to patient outcomes and community, rises right to the top,” Narveson said. “When people first start with the organization and their stock ownership grows, you can see how their outlook becomes that of an owner. It behooves all of them to do the best they possibly can to take care of that customer and go the extra mile so they benefit the patient, the organization and personally.”

All of the factors that have made Thrifty White innovative — from its employee-owners and its early adoption of med sync to its burgeoning specialty pharmacy business and its commitment to patient engagement to improve health and reduce healthcare costs — have, to the company’s leadership team, simply been a matter of course.

“It’s not good enough to just be a drug store on the corner of First and Main — anyone can do that,” Narveson said. “If you’re not bringing value to the healthcare system and reducing overall healthcare spend, others will be. … You have to be continuously working at how you’re going to exceed expectations in those areas, otherwise you’re not going to have a seat at the table. … We’ve taken as a challenge to our organization that we want to stay ahead of that curve and make sure we’re demonstrating results that show we deserve a seat at the table — because the people who don’t show the value that’s required to be part of the overall picture in the future will fall behind.”

Legislative progress: Q&A with NACDS’s Steve Anderson

Drug Store News caught up with NACDS president and CEO Steve Anderson for a recap of 2016 and a look ahead at what to expect from a Trump administration.

DSN: What is the RxImpact scorecard for 2016? How did the industry do on the key pharmacy and patient access issues?

Steve Anderson: We have two examples right now. As I’m answering this question, Congress is preparing to consider final passage of two bills — 21st Century Cures and the National Defense Authorization Act. Both bills reflect pro-patient, pro-pharmacy achievements. The Cures legislation, which NACDS supports for its emphasis on fostering healthcare innovation, was finalized without including a damaging provision that would have used reductions in Medicaid pharmacy reimbursement to help pay for the bill. That was something NACDS had to advocate on quite aggressively. The defense bill includes the NACDS-supported TRICARE pilot program, which will maintain the ability of military families and veterans to obtain their prescriptions at the pharmacy of their choice, while providing significant savings to the Department of Defense. Regarding the bill to enhance underserved Medicare patients’s access to pharmacy services — the Pharmacy and Medically Underserved Areas Enhancement Act — it earned the backing of two-thirds of the U.S. House of Representatives and half of the Senate. That bill, which we call the “provider status” bill, has a strong start.

DSN: What major pharmacy-related issues do you expect to be on the table for 2017, and what does the outlook look like? Take provider status — do you think the changes in Congress will help or hurt the industry's chances of seeing meaningful provider status legislation for pharmacists in the next year or two?

Anderson: NACDS already has reached out to President-elect Donald Trump’s transition team and to Congressional leaders. We are putting a number of issues on the table. Provider status is one of them. We have made the case to the NACDS membership that it will be essential to come to Washington for NACDS RxIMPACT Day on Capitol Hill to help fill the void of 40 cosponsors of the bill who are not returning to Congress. We need to keep that bill positioned to be included on some other piece of legislation that may move in Congress. We will be advancing various pharmacist scope-of-practice proposals in the states; bird-dogging the implementation of Medicaid pharmacy reimbursement for prescription drugs and any potential changes to the Affordable Care Act; and keeping up the fight on TRICARE, Medicaid managed care and issues related to healthcare plan practices, such as direct and indirect remuneration fees, among others.

DSN: What are some key pharmacy statistics the new Trump administration and freshman Congressional leaders need to know?

Anderson: Some say that making one’s case in Washington, D.C. comes down to people and data. NACDS has great data and great people. Nearly all Americans (91%) live within five miles of a community pharmacy. For 13 straight years, pharmacists have ranked in the top three professions in Gallup’s national Honesty and Integrity survey — and pharmacists were second, behind nurses, in 2015. Here’s a great one: At the 2016 NACDS RxIMPACT Day on Capitol Hill, advocates met with 90% of the 535 Congressional offices. And, there is a store operated by an NACDS member in every Congressional District.

DSN: What might it mean for community pharmacy if Trump follows through on some form of his promise to “remove and replace” the ACA? He has talked about keeping the pre-existing condition and the extended coverage for adult children provisions, which are both cost centers. How can/is retail pharmacy helping to mitigate those costs?

Anderson: One of the issues on which NACDS will remain very active is fighting for a workable approach to Medicaid pharmacy reimbursement for prescription drugs — an approach that preserves patient access. NACDS did not take a position on the Affordable Care Act as a whole, and rather advocated on pharmacy-specific provisions. Currently, NACDS is focused on ensuring the new reimbursement model under the Affordable Care Act provision is workable in terms of how it is being implemented. If something happens that eliminates the provision entirely, then we are going to have to be right on point to defend pharmacy patient care.

DSN: Looking back on the Obama administration, what would you say have been some of the biggest wins for community pharmacy and/or some accomplishments or moments NACDS is particularly proud of?

Anderson: NACDS placed an ad in The Washington Post in 2007, targeted to all of the Republican and Democratic candidates for their parties’s Presidential nominations in 2008. That was when President Barack Obama was Senator Obama. Healthcare reform discussions were just beginning, and NACDS said that pharmacy wanted and needed to be part of these discussions. Throughout the Affordable Care Act debate, NACDS told pharmacy’s story, and made great progress. NACDS has defended the industry on [such] issues [as] Medicaid reimbursement while charting new territory on everything from point-of-care testing and expanded vaccination authority to new opportunities for medication therapy management. Now, we are working on additional scope-of-practice expansion, the pharmacist provider-status legislation, pharmacy’s role in value-based healthcare models and much more. It is going to be a fast-paced 2017.

Trump’s plan to shift the cost burden

That’s the mandate many Americans have for President-elect Donald Trump’s first 100 days in office. In fact, as many as 76% identified health care as the leading policy issue they’d like to see addressed by the new administration and a Republican-controlled Congress, according to a PricewaterhouseCoopers Health Research Institute Consumer Survey conducted in September, though the economy (79%) and national security (76%) were leading concerns as well.

Specifically, 64% of Americans want their health insurance to be more affordable; 62% think lowering the cost of health services should be a priority; 56% support lowering prescription drug costs; and 33% would like to see regulatory impediments placed on insurance company profits.

Trump has already identified a number of ways in which to make health care affordable again, chief among which is the proposed repeal and replacement of the Affordable Care Act. “While the [ACA] has reduced the number of uninsured people and accelerated the shift to a more value-based healthcare system, it has struggled to lower costs, make care more affordable and win over a majority of Americans,” wrote PwC in an analysis following the election.

Trump’s nomination of Rep. Tom Price, R-Ga., to lead the Department of Health and Human Services and Seema Verma to lead the Centers for Medicare and Medicaid Services is a strong indication of the direction health care will take under a Trump administration. And those changes are expected to be implemented over two to three years, according to reports, giving the industry time to adapt new business models.

Price advocates the Republican party’s “Better Way” platform that calls for eliminating the individual mandate but keeping the pre-existing condition provision, and allowing young adults to remain on their parents’ plans up to age 26. That plan also calls for shifting Medicaid reform to the state level, which is Verma’s area of expertise. She is best known as the architect behind Indiana’s Medicaid expansion model — known as Healthy Indiana Plan 2.0.

The bottom line behind Trump’s proposals: The cost burden of the $3 trillion industry will shift away from the federal government and toward private enterprise, state government and consumers. Here are the key pieces of health policy change Trump is expected to make early on:

One of Trump’s campaign promises was to immediately repeal and replace the ACA, though some key patient-friendly provisions may be kept in place. Ultimately, this is expected to increase the number of uninsured by as much as 20 million patients, according to a September Commonwealth Fund study. That will significantly reduce spending on pharmaceuticals, as well as demand for healthcare services, which could negatively impact retail pharmacy.

Trump favors the delivery of healthcare services that mimic many retail offerings. This would be a boon for the retail pharmacy sector, as Trump’s focus on retail-oriented health care will attract investment. If Trump delivers on his pledge to reduce federal regulations, the additional reduction in go-to-market costs may spawn more disruptive innovation within the retail sector.

Trump advocates selling insurance across state lines in an effort to reduce the cost of insurance premiums. Selling insurance across state lines would necessitate broad provider networks to be established by insurers and providers.

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